Becker's Hospital Review

39 39 CEO/STRATEGY effects of continuous exposure to violence. One way Stroger takes a longitudinal ap- proach to trauma care is through Healing Hurt People-Chicago. e program is in- formed by hospital-based violence interven- tion strategies developed by the Center for Nonviolence and Social Justice at Philadel- phia-based Drexel University. "Just as in medical trauma care that has a 'gold- en hour' to save somebody's life, we also have this opportunity when somebody is brought to the hospital to provide a type of violence intervention and to stop the cycle of violence," said Andy Wheeler, one of the trauma center's licensed clinical social workers. e Chicago program, launched in August 2013, is a collaboration between teams at Stroger, Drexel and the UChicago Medicine Comer Children's Hospital, which operates a pediatric level 1 trauma center. It encompass- es a team of specialized social workers, called trauma intervention specialists, who identify pediatric patients in need of ongoing case management, mentorship and group therapy services for six months to one year aer the patient's discharge from the hospital. ere are nearly 60 active street gangs in Chicago, with 100,000 members, according to estimates from the Chicago Crime Com- mission, contributing to a culture of retal- iatory shootings where the same patients might cycle in and out of the trauma center multiple times. Healing Hurt People-Chica- go's mission is to reduce the likelihood a gun- shot wound patient will return to the hospital with another violent injury, largely by giving patients strategies to avoid crime and other risks in their community. Five hundred patients have gone through HHP-Chicago's program since 2013. Only 7 percent of patients who participated for six months or longer returned to the hospi- tal with another violent injury. None of the patients committed an act of retaliation, ac- cording to the Rev. Carol Reese, HHP-Chica- go's program director. "Whether they're in a gang or not, the issue is about ongoing safety of the people taking part in Healing Hurt People," she said. "Just being from the 'wrong neighborhood' can make people a target in some areas, so it's more about helping patients identify where it is safe for them to be. Social connections with peers are powerful for young people and can serve to protect, as well as create increased risk." Even back at the hospital, recovery doesn't end post-discharge. Stroger's trauma physicians re- main in contact with the patients they've treated. "Our patients belong to our group of physi- cians forever. It's not like we back off of them aer we patch them up in the ED," Faran Bokhari, MD, chairman of Cook Coun- ty health system's trauma and burn unit, told Becker's. "is is interpersonal violence, and you're oen dealing with the re-injury of these same people over a long period of time. A lot of our patients, we've known them for 20 or 30 years. ey were really young when they [first] came to us." 'If it doesn't bother you, then you're burning out' e high stress environment and impossi- bility of saving every patient admitted to Stroger's trauma center — along with the repetitive nature of caring for patients in a city affected by gang violence — can take an emotional toll on even the most resilient pro- viders. e work can also be physically tax- ing, as it can take up to two hours to stabilize a gunshot wound patient. One way the trauma team at Stroger combats burnout is by talking through difficult outcomes. "We review every death, and everybody gets to say, 'Well, what did we do?'" Dr. Bar- rett said. "And this is not a 'what did we do wrong' conversation." ese conversations are meant to improve protocols and allow staff to emotionally pro- cess the situation. It's not about blaming any- one for the outcome, he said. "I recall a woman who was pregnant with twins, and we lost her and both of the babies," Dr. Barrett said. "It doesn't matter whether or not you did everything right, you're [going to wonder] how could this possibly happen. If it doesn't bother you, then you're burning out, and that's bad too. As a leader you need to be very cognizant of that." Staff at Stroger said the camaraderie among the trauma center's 50 clinicians is a hallmark of the unit. Most nurses and physicians stay with the trauma center for 20 years. "Being a trauma nurse, it's very important to have that communication with the trauma doctors," said Cristina Federighi, RN, MSN, who has been a trauma nurse at Stroger for more than 25 years. "To achieve the best care for our patients, it's all about communica- tion. It's the key to effective care. We have to have that relationship." Trauma staff have the option to meet with the same social workers their patients see. Mr. Wheeler said clinicians who witness traumatic injuries daily can display some of the same behavioral symptoms as someone who's been injured. Mr. Wheeler conducts self-care workshops for Stroger's critical care and palliative care providers, which include mindfulness and meditation. "When you go through social work training, you learn a lot about self-care," Mr. Wheeler said. "As far as I know that isn't taught as much in medical school and through residency." Stroger on the front lines Cook County health system's leadership, administrative staff and clinicians work tire- lessly to uphold the trauma center's role as a community asset. "e success of the trauma unit would really be the lack of its existence," Dr. Bokhari said. "e challenge is the socioeconomic factors that lead to this violence. is is something that has evolved over hundreds of years, and you can't fix it in a day." e hospital also recognizes the factors at play beyond the city's limits. On March 24, Dr. Shannon, staff and former patients joined the student-led March for Our Lives demonstration in Washington, D.C., in sup- port of universal background checks and stricter laws on buying guns, along with oth- er firearm legislation. "ese are areas where you realize that your health system as a healthcare delivery plat- form is limited. You've got to think beyond that to start thinking about the social circum- stances in the communities that you serve," Dr. Shannon said. "You're not doing your job well if you're working in a safety net [and] not addressing violence in the community." n "The success of the trauma unit would really be the lack of its existence. The challenge is the socioeconomic factors that lead to this violence." — Dr. Faran Bokhari, chairman, trauma and burn unit

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